CUSP 4 MVP – VAP Quantitative Implementation Assessment 1: Aggregated Results Kisha Ali, MS Mayo Levering, BS September 2, 2014

Implementation Assessment 1 ICU collaborative developed the Team Checkup Tool (TCT) in 2005 during the MHA Keystone Designed to close the gap between hospital executives and frontline teams Purpose help identify and work with teams to provide needed training, resources, or other aids Pioneered in the CUSP for VAP Maryland and Pennsylvania Pilot Project 2

Implementation Assessment 2 Measures implementation components and contextual factors that affect quality improvement initiatives A metric that allows implementation of a project to be quantified Consist of a quantitative and qualitative portion, these are the results of the quantitative portion Quantitative portion completed online sample of participants are interviewed via telephone for the open-ended qualitative part of the tool 3

Unit Participation: Results of Compliance Participation Overall: Participation by State : 4 Total Number of Units Participating the Project Total Number of Units Completed Implementation Assessment Total Number of Participating States Total Respondents in Project Contributing to Result Data (%) State Number of Units Completed Implementation Assessment Number of Units in that State Compliance Per State (%) Contribution to Result Data (%) Florida South Carolina Texas New Jersey Michigan Missouri0100 Virginia0200

Implementation Assessment 1 Tool Aggregated Quantitative Results focuses on 7 measures: 1. Training on patient safety 2. Leadership commitment and support 3. Implementation of CUSP tools 4. Implementation of CUSP 4 MVP-VAP bundle 5. Data review 6. Barriers to progress 7. Team engagement 5

Measure 1: Results from Training on Patient Safety 6 How many of your staff have viewed a video or presentation on the Science of Safety? Is a patient safety presentation now part of your new staff or unit orientation for all patient care providers (e.g. physicians, nurses, respiratory therapists)? Yes27.3% No, but preparing to do this54.5% No, with no current plans to do so0% Don’t Know18.2% Percentage of Units

Measure 2: Leadership Commitment and Support Is your leadership taking the following steps to reinforce its support for the work? 7 Percentage of Units

Measure 2: Leadership Commitment and Support Unit leaders: How actively engaged have the unit leaders been with your CUSP 4 MVP-VAP project and VAE prevention? 8 Hospital leaders: How actively engaged have the hospital leaders been with your CUSP 4 MVP-VAP project and VAE prevention?

Measure 3: Implementation of CUSP Tools The CUSP process consists of implementing the following tools to improve teamwork and communication. Please indicate whether you have implemented any of these CUSP components in your VAE process thus far? 9 Percentage of Units

Measure 3: Implementation of CUSP Tools 10 Have you conducted a Staff Safety Assessment with your unit staff about how the next patient might be harmed, to identify potential safety risks in the unit? Have you grouped and prioritized the safety issues that emerged from the safety assessment you conducted with your staff? Yes63.7% No22.7% Don’t Know13.6% Percentage of Units

Measure 4: Implementation of CUSP 4 MVP - VAP Bundle The CUSP 4 MVP-VAP Toolkit lays out the following steps to be taken in implementing the bundle for ventilator-associated event (VAE) prevention. Please indicate whether you have taken each of these steps in your implementation process thus far? 11 Percentage of Units

Measure 5: Data Review and Sharing How often is the CUSP team taking the following steps to review data on VAE rates and other performance data (e.g., process data, barriers faced), and share this information with other key stakeholders? 12 Percentage of Units

Measure 6: Barriers to Progress In the past three months, how often did each of the following factors slow your CUSP 4 MVP- VAP team's progress in implementing the CUSP and VAE prevention interventions? 13 All Units (n=31) Number of Possible Barriers All Barriers18 Barrier group: Leadership support issues4 Team skills and cohesion issues6 Stakeholder push ‐ back issues3 Workload and time issues5

Measure 6: Barriers to Progress In the past three months, how often did each of the following factors slow your CUSP 4 MVP- VAP team's progress in implementing the CUSP and VAE prevention interventions? 14 Answer Options Never/ Rarely OccasionallyFrequentlyAlmost Always Response Count Insufficient knowledge of evidence supporting interventions Not enough leadership support from executives Not enough leadership support from physicians Not enough leadership support from nurses Insufficient autonomy/authority Lack of quality improvement skills Confusion about how to proceed with CUSP activities Lack of team member consensus regarding goals Inability of team members to work together Turnover on CUSP team Not enough buy-in from physician staff Not enough buy-in from nursing staff Not enough buy-in from other staff Not enough time Staff turnover on unit Data collection burden for staff Problems with data systems Competing priorities or distractions

Measure 7: Unit-Level Team Engagement On a scale of 1 to 5 (5 being the most), please indicate your team's level of engagement in the process of implementing the CUSP 4MVP-VAP and CUSP components of the intervention. 15 Percentage of Units

Conclusion Results for 31 Quantitative Implementation Assessments in Cohort 1 Have sampled a number of units from the quantitative for the qualitative portion Have begun qualitative analysis of these interviews Assessments will continue to be administered semi-annually Units will track implementation successes and barriers of the CUSP tools and the CUSP4MVP-VAP interventions over time 16

Reference 17 1.Lubomski LH, Marsteller JA, Hsu YJ, Goeschel CA, Holzmueller CG, and Pronovost PJ. Team Checkup Tool: Evaluating QI Team Activities and Giving Feedback to Senior Leaders. Joint Commission Journal of Quality and Patient Safety. 2008; 34(10): Ali KJ, Farley DO, Speck K, Catanzaro M, Wicker K and. Berenholtz SM. Measurement of Implementation Components and Contextual Factors in a Two-State Healthcare Quality Initiative to Reduce Ventilator-Associated Pneumonia. Infection Control and Hospital Epidemiology. 2014; 35(10): [in press].